On Sat, Feb 2, 2013 at 12:00 PM, Keith Lofstrom <[email protected]> wrote: > On Fri, Feb 01, 2013 at 04:33:30PM -0800, Clinton . wrote: >> According to a recent RAND Corp. study, the efficiency gains hoped for with >> EMRs have been stifled due to the incompatibilities between different >> systems. > > That is EXACTLY why OpenEMR (and Diane's presentation) is so > important to open source and our community. The people at > the meeting Thursday night can change the world. Bring > your doctor with you. I'm bringing two doctors! > > > While compatability IS a problem, the specifics vary between > regions and practices. Portland is dominated by Providence, > Legacy, Kaiser, OHSU, and Adventist. All these organizations > use EPIC (http://www.epic.com/) and spend tens of millions of > dollars a year on configuration, training, and support. > > And, surprisingly, all these big EPIC systems do NOT > interchange data. A Portland doctor can use the Providence > EPIC web portal to look at any Providence patient's data > from Alaska to northern California, but they cannot combine > that data with data from Legacy, if the same patient went to > Legacy for an emergency room visit, an X-Ray, or a lab test. > > Medium-sized primary care organizations ( i.e. Portland Clinic) > also use EPIC. Small clinics (1 to 20 doctors) use many different > EMRs, some "free on the web", some purchased at great expense, > etc. And as you say, interchange of "live" data between these > EMRs doesn't happen - at best, data is moved as unstructured > text or images. > > Many small clinics do NOT use EMR, because they can be a > P.I.T.A., enforcing "one size fits all" operating procedures, > often incompatable with the unique way many doctors practice > For good reasons - patients are unique, too. > > More importantly, many practices have been bankrupted when > the proprietary vendors jacked up their prices, with patient > data inaccessable in proprietary formats and not migratable > to other EMRs. To many vendors, anti-interoperable design > is a monopolistic feature, not a bug. > > That does not mean no interchange happens. Some of the EPIC > systems allow doctors to "print to file", which they can save > in their own EMR's. However, that is complicated, and it is not > "structured data", meaning that only humans and not algorithms > can search the interchanged data. However, if the images are > digitized, then someday machine can parse them - as opposed to > handwritten notes, phone slips, etc. in a fat manila envelope. > > And someday, that historical data from 10 or 30 years ago will > be vital to new kinds of treatment. A chicken and egg problem: > developing history-based treatments requires detailed history, > and there's little justification for maintaining the detailed > history without those treatments. > > The interchange is improving. Legacy has a "small practice > IT outreach" staff working hard to make their structured data > interchange with other EMRs. The manager is interested in > working with us for OpenEMR interchange. It helps A LOT > when the target EMR is open source. This may work out like > the reverse engineering Andrew Tridgell did that resulted > in Samba accessing SMB, and Git replacing Bitkeeper. > > So - all the reasons that we love free software, and that > Portland is a great place to do it, are also the reasons we > should extend free software into medical informatics here in > our community, creating new businesses and keeping ourselves > and our neighbors alive. This could be the NEXT BIG THING, > and if local doctors and software people work together, we > could make Portland the global hub for medical informatics. > > You choose - professional success and personal longevity, > or paying monopolists for bad software and bad medicine? > If your career and life matter to you, show up Thursday, > and bring your doctor with you. > > Keith > > -- > Keith Lofstrom [email protected] Voice (503)-520-1993
I doubt I can bring any doctors, but would it be possible/practical to have a video of the talk for distribution to a doctor or two? -Denis _______________________________________________ PLUG mailing list [email protected] http://lists.pdxlinux.org/mailman/listinfo/plug
